Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan heart failure trial (Val-HeFT) echocardiographic data

Maylene Wong, Lidia Staszewsky, Roberto Latini, Simona Barlera, Robert Glazer, Nora Aknay, Allen Hester, Inder Anand, Jay N Cohn

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

Objectives The objective of this study was to test the hypothesis that the severity of left ventricular remodeling predicts the response to treatment and outcomes in chronic heart failure. Background Reversal of remodeling should produce the most favorable outcome in patients with the most severe remodeling. Methods In 5,010 heart failure patients on background therapy and randomized to valsartan and placebo, serial recordings of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) were read at sites that had to meet qualifying standards before participating. Baseline LVIDd and EF were pooled across treatments and retrospectively grouped by quartiles Q1 to Q4, representing best to worst. Kaplan-Meier survival curves were obtained by the log-rank test. Q1 was compared with Q4 for mortality and combined mortality and morbidity (M + M) from Cox regression risk ratios (RRs). Valsartan versus placebo changes from baseline in LVIDd and EF were analyzed by quartiles from analysis of covariance. Valsartan and placebo were compared by RRs for M + M. Results Survival rates were greater in the better quartiles for LVIDd and EF (p < 0.00001). The RR for Q1 versus Q4 in events approached 0.5 for both LVIDd and EF (p < 0.0001). An LVIDd decrease and EF increase were quartile-dependent and greater with valsartan than placebo at virtually all time points. The RR for M + M outcomes favored valsartan in the worse quartiles. Conclusions Stratification by baseline severity of remodeling showed that patients with worse LVIDd and EF are at highest risk for an event, yet appear to gain the most anti-remodeling effect and clinical benefit with valsartan treatment.

Original languageEnglish (US)
Pages (from-to)2022-2027
Number of pages6
JournalJournal of the American College of Cardiology
Volume43
Issue number11
DOIs
StatePublished - Jun 2 2004

Fingerprint

Valsartan
Ventricular Remodeling
Heart Failure
Odds Ratio
Placebos
Therapeutics
Mortality
Kaplan-Meier Estimate
Survival Rate
Morbidity

Keywords

  • ACE
  • ANCOVA
  • BB
  • EF
  • HF
  • LV
  • LVIDd
  • M + M
  • RR
  • analysis of covariance
  • angiotensin-converting enzyme
  • beta-blocker
  • combined mortality and morbidity
  • ejection fraction
  • heart failure
  • left ventricle/ ventricular
  • left ventricular internal diastolic diameter

Cite this

Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure : Valsartan heart failure trial (Val-HeFT) echocardiographic data. / Wong, Maylene; Staszewsky, Lidia; Latini, Roberto; Barlera, Simona; Glazer, Robert; Aknay, Nora; Hester, Allen; Anand, Inder; Cohn, Jay N.

In: Journal of the American College of Cardiology, Vol. 43, No. 11, 02.06.2004, p. 2022-2027.

Research output: Contribution to journalArticle

Wong, Maylene ; Staszewsky, Lidia ; Latini, Roberto ; Barlera, Simona ; Glazer, Robert ; Aknay, Nora ; Hester, Allen ; Anand, Inder ; Cohn, Jay N. / Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure : Valsartan heart failure trial (Val-HeFT) echocardiographic data. In: Journal of the American College of Cardiology. 2004 ; Vol. 43, No. 11. pp. 2022-2027.
@article{30bee18b70b34ae199b27060ab803b04,
title = "Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan heart failure trial (Val-HeFT) echocardiographic data",
abstract = "Objectives The objective of this study was to test the hypothesis that the severity of left ventricular remodeling predicts the response to treatment and outcomes in chronic heart failure. Background Reversal of remodeling should produce the most favorable outcome in patients with the most severe remodeling. Methods In 5,010 heart failure patients on background therapy and randomized to valsartan and placebo, serial recordings of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) were read at sites that had to meet qualifying standards before participating. Baseline LVIDd and EF were pooled across treatments and retrospectively grouped by quartiles Q1 to Q4, representing best to worst. Kaplan-Meier survival curves were obtained by the log-rank test. Q1 was compared with Q4 for mortality and combined mortality and morbidity (M + M) from Cox regression risk ratios (RRs). Valsartan versus placebo changes from baseline in LVIDd and EF were analyzed by quartiles from analysis of covariance. Valsartan and placebo were compared by RRs for M + M. Results Survival rates were greater in the better quartiles for LVIDd and EF (p < 0.00001). The RR for Q1 versus Q4 in events approached 0.5 for both LVIDd and EF (p < 0.0001). An LVIDd decrease and EF increase were quartile-dependent and greater with valsartan than placebo at virtually all time points. The RR for M + M outcomes favored valsartan in the worse quartiles. Conclusions Stratification by baseline severity of remodeling showed that patients with worse LVIDd and EF are at highest risk for an event, yet appear to gain the most anti-remodeling effect and clinical benefit with valsartan treatment.",
keywords = "ACE, ANCOVA, BB, EF, HF, LV, LVIDd, M + M, RR, analysis of covariance, angiotensin-converting enzyme, beta-blocker, combined mortality and morbidity, ejection fraction, heart failure, left ventricle/ ventricular, left ventricular internal diastolic diameter",
author = "Maylene Wong and Lidia Staszewsky and Roberto Latini and Simona Barlera and Robert Glazer and Nora Aknay and Allen Hester and Inder Anand and Cohn, {Jay N}",
year = "2004",
month = "6",
day = "2",
doi = "10.1016/j.jacc.2003.12.053",
language = "English (US)",
volume = "43",
pages = "2022--2027",
journal = "Journal of the American College of Cardiology.",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "11",

}

TY - JOUR

T1 - Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure

T2 - Valsartan heart failure trial (Val-HeFT) echocardiographic data

AU - Wong, Maylene

AU - Staszewsky, Lidia

AU - Latini, Roberto

AU - Barlera, Simona

AU - Glazer, Robert

AU - Aknay, Nora

AU - Hester, Allen

AU - Anand, Inder

AU - Cohn, Jay N

PY - 2004/6/2

Y1 - 2004/6/2

N2 - Objectives The objective of this study was to test the hypothesis that the severity of left ventricular remodeling predicts the response to treatment and outcomes in chronic heart failure. Background Reversal of remodeling should produce the most favorable outcome in patients with the most severe remodeling. Methods In 5,010 heart failure patients on background therapy and randomized to valsartan and placebo, serial recordings of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) were read at sites that had to meet qualifying standards before participating. Baseline LVIDd and EF were pooled across treatments and retrospectively grouped by quartiles Q1 to Q4, representing best to worst. Kaplan-Meier survival curves were obtained by the log-rank test. Q1 was compared with Q4 for mortality and combined mortality and morbidity (M + M) from Cox regression risk ratios (RRs). Valsartan versus placebo changes from baseline in LVIDd and EF were analyzed by quartiles from analysis of covariance. Valsartan and placebo were compared by RRs for M + M. Results Survival rates were greater in the better quartiles for LVIDd and EF (p < 0.00001). The RR for Q1 versus Q4 in events approached 0.5 for both LVIDd and EF (p < 0.0001). An LVIDd decrease and EF increase were quartile-dependent and greater with valsartan than placebo at virtually all time points. The RR for M + M outcomes favored valsartan in the worse quartiles. Conclusions Stratification by baseline severity of remodeling showed that patients with worse LVIDd and EF are at highest risk for an event, yet appear to gain the most anti-remodeling effect and clinical benefit with valsartan treatment.

AB - Objectives The objective of this study was to test the hypothesis that the severity of left ventricular remodeling predicts the response to treatment and outcomes in chronic heart failure. Background Reversal of remodeling should produce the most favorable outcome in patients with the most severe remodeling. Methods In 5,010 heart failure patients on background therapy and randomized to valsartan and placebo, serial recordings of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) were read at sites that had to meet qualifying standards before participating. Baseline LVIDd and EF were pooled across treatments and retrospectively grouped by quartiles Q1 to Q4, representing best to worst. Kaplan-Meier survival curves were obtained by the log-rank test. Q1 was compared with Q4 for mortality and combined mortality and morbidity (M + M) from Cox regression risk ratios (RRs). Valsartan versus placebo changes from baseline in LVIDd and EF were analyzed by quartiles from analysis of covariance. Valsartan and placebo were compared by RRs for M + M. Results Survival rates were greater in the better quartiles for LVIDd and EF (p < 0.00001). The RR for Q1 versus Q4 in events approached 0.5 for both LVIDd and EF (p < 0.0001). An LVIDd decrease and EF increase were quartile-dependent and greater with valsartan than placebo at virtually all time points. The RR for M + M outcomes favored valsartan in the worse quartiles. Conclusions Stratification by baseline severity of remodeling showed that patients with worse LVIDd and EF are at highest risk for an event, yet appear to gain the most anti-remodeling effect and clinical benefit with valsartan treatment.

KW - ACE

KW - ANCOVA

KW - BB

KW - EF

KW - HF

KW - LV

KW - LVIDd

KW - M + M

KW - RR

KW - analysis of covariance

KW - angiotensin-converting enzyme

KW - beta-blocker

KW - combined mortality and morbidity

KW - ejection fraction

KW - heart failure

KW - left ventricle/ ventricular

KW - left ventricular internal diastolic diameter

UR - http://www.scopus.com/inward/record.url?scp=2542492890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2542492890&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2003.12.053

DO - 10.1016/j.jacc.2003.12.053

M3 - Article

C2 - 15172407

AN - SCOPUS:2542492890

VL - 43

SP - 2022

EP - 2027

JO - Journal of the American College of Cardiology.

JF - Journal of the American College of Cardiology.

SN - 0735-1097

IS - 11

ER -